The psychological burden of diabetes: common mental health disorders, their impact on disease outcomes and strategies for intervention.

Abstract

Diabetes mellitus is associated with a high burden of mental health issues, including both formal psychiatric disorders, such as depression and anxiety, and diabetes-specific psychological challenges like diabetes-related distress, psychological insulin resistance, and fear of hypoglycemia. These mental health difficulties significantly impair self-management, treatment adherence, and quality of life, increasing the risk of complications and mortality. The paper reviews the bidirectional relationship between diabetes and mental disorders, driven by biological and behavioural mechanisms. It highlights the high prevalence of depression, anxiety, cognitive impairment, and eating disorders among people with diabetes. The consequences of untreated mental health conditions include poor glycemic control, greater healthcare costs, increased hospitalization, and lower health-related quality of life. The review presents a range of evidence-based management strategies, including early screening, psychological and pharmacological interventions, lifestyle changes, and integrated collaborative care models. Particular emphasis is placed on the role of physicians and endocrinologists in recognizing and managing psychological difficulties. The paper also discusses challenges in low-resource settings and underscores the need for culturally adapted accessible interventions. It argues for a paradigm shift towards integrated, person-centred care models that address both physical and mental health needs in diabetes, offering practical recommendations for clinicians and policymakers.